Dispelling nutrition myths, ranting, and occasionally, raving

To keto or not to keto

I feel like there’s one thing missing from a lot of the discussion about the keto diet (and similar extreme diets, really). Everyone talks a lot about whether or not it “works” with proponents on both sides, research supporting both sides, arguing that it does or doesn’t work for weight loss. The problem with this is the assumption that weight loss is the most important feature of a good diet. It’s not. You can lose weight eating lots of things that are not going to provide you with the nutrients you need. Weight loss is not the most important thing for health, despite what the media, the “wellness” industry, society, and even many health care professionals have lead us to believe.

Just because you feel good on a ketogenic diet and are losing weight doesn’t mean that it’s a good idea. As a dietitian, this is something that I really struggle with. It’s our job to support people. We can tell them that keto is a difficult diet to follow, that it may not be advisable, but when it comes down to it, they decide if it’s something they want to pursue or not. And if they do decide to pursue it, we can’t say “well, good luck, I wash my hands of you”. We have to help them undertake it in as healthy a way as possible. Which kind of blows my mind (and makes me glad that I don’t work in a counselling role) because if someone came to us with an eating disorder we wouldn’t support them in that. How can it be ethical for us to support people in following a diet that may cause them harm?

A little history of keto: the ketogenic diet originated as a treatment for epilepsy in children in the 1920s. It was intended to mimic the effects of fasting through the generation of ketones. In recent years this concept has caught on with people desiring to lose weight. After all, if ketones are produced during fasting, then if a specific diet can promote the production of ketones, it may also lead to weight loss. Not illogical. In some children with epilepsy who do not experience a reduction in seizures with medications, the ketogenic diet can be an effective treatment. However, there are potential side-effects.

A few long-term studies (1, 2) have looked at the effects of the ketogenic diet in children and have found such side-effects as: kidney stones, slowed growth, dyslipidemia, and fractures. There are also short-term risks (2, 3, 4) associated with the diet in children with epilepsy including: acidosis, hypoglycemia, gastrointestinal distress (including vomiting, constipation, diarrhoea, and abdominal pain) dehydration, hypoproteinemia, and lethargy. All of these studies have found low long-term adherence among children. There are many reasons for this: some children see improvement in symptoms, even after discontinuing the diet, others find it difficult to adhere to the diet, for some it’s not effective.

Of course, adults who wish to lose weight are not the same as children who have epilepsy. It’s hard to say if slowed growth in children would have a similar counterpart in an adult. However, many of the short-term side effects may be seen in adults, as may some of the other long-term side effects. In addition, there is potential for nutrient deficiencies when following such a restricted diet. Unfortunately, we don’t have research into the long-term effects of a ketogenic diet on adults using it for weight loss. We have some short-term studies that primarily look at it from the standpoint of whether or not it’s an effective weight loss diet. Maybe it’s perfectly safe, but maybe it’s not. Given that the vast majority of people who lose weight on the diet end up regaining it, and often more, is it really worth taking that risk? By following a keto diet you’re basically enrolling yourself in an uncontrolled experiment.

I think it would be interesting to know what the long-term effects of a ketogenic diet for weight loss are in adults. What I’d really like to know though is why we have become so obsessed with being thin that we are willing to adopt disordered eating habits at the expense of other aspects of our health and well-being. Why is it when we talk about a diet “working” we de facto mean weight loss? Why have we come to value weight loss over every other indicator of health? Why can’t we just value ourselves enough to properly nourish our bodies?

5 thoughts on “To keto or not to keto”

Yes! Being thin does not necessarily equal healthy. It’s a similar thing with a vegan diet………being vegan does not necessarily equal being healthy. Oreo cookies are vegan; you could just eat those cookies and be vegan. Looking at the nutrition values of food
seems to make a lot more sense.

Hi Diana,
An interesting post. I have a different take on your comment: “How can it be ethical for us to support people in following a diet that may cause them harm?”.

The reality is that you probably already do. And who could fault you or any other Dietitian for doing so since what is supposedly good for us may be determined to be bad for us a year from now and what is currently bad may become perfectly acceptable.

It appears that this post was based on your assessment of one research document and your conclusion is that Keto is bad. The conclusion section of that same research document seems to suggest that the door is not as closed as you appear to see it:

“CONCLUSIONS The past decade has been an amazing one for those interested in the KD. Its increasing use in children with difficult-to-control seizures has opened new vistas for these children and also for our understanding of epilepsy. Its potential use in adults by using a less restrictive Atkins diet may make a difference to this population as well. The diet’s documented efficacy and tolerability have opened new horizons as it is tried for a variety of ills from brain tumors to migraine, and from head trauma to eurodegenerative diseases. Most exciting is the realization that beliefs concerning a high-fat diet making people fat and dyslipidemic have been proven false. Researchers are rediscovering that ketone bodies are not necessarily bad and that glucose is not necessarily good. A whole new era of metabolic research has opened up. It is not completely clear where it will lead, but its promise is exciting.”

That conclusion, for an 11 year old (2007) study, would have encouraged me to search for newer studies.

A couple of the experts that I follow are Dom D’Agostino, Ph.D https://www.ketonutrition.org/ and Dr. Rhonda Patrick https://www.foundmyfitness.com They have both been on Joe Rogan’s show numerous times if you or others are interested in hearing what they have to say and the research they have done.
You can also check out Robb Wolfe…a well respected researcher – https://robbwolf.com/about/.
I also follow, to a lesser degree, Dr Perlmutter https://www.drperlmutter.com/ (fascinating podcast interviews, especially related to cancer and autoimmune research) & Maria Emmerich http://mariamindbodyhealth.com/ for her recipes (although she has become very sales oriented in the last few months, which makes me less trusting of her advice…her husbands experience with Lyme disease could be helpful as that disease continues to spread into our part of Ontario).

I personally know people who are on the Keto diet and while some are seeking a way to lose excess body fat others are using it as a way to improve their over all health.

My thoughts in answer to your questions:
Q) I think it would be interesting to know what the long-term effects of a ketogenic diet for weight loss are in adults.
A) We are seeing some of it in the research presented by the people I have identified above…there are many others doing research as well. Good, peer reviewed, research takes time as you know so it will come.
Q) What I’d really like to know though is why we have become so obsessed with being thin that we are willing to adopt disordered eating habits at the expense of other aspects of our health and well-being.
A) Of the people I know who are trying the Keto diet none are on it for aesthetics though their reasons are all different.
Q) Why is it when we talk about a diet “working” we de facto mean weight loss?
A) Most call Keto a life style for that very reason.
Q) Why have we come to value weight loss over every other indicator of health?
A) Are you certain that isn’t an assumption? Even if the assumption is correct it is true that obesity is linked to almost all major illnesses. As a friend recent paraphrased Dom “It’s not how long we live before our time on Earth comes to an end but how we get to that end”. Having more energy, clarity of mind, and a long list of other reported benefits sure beats spending the last ten years of ones life with tubes coming out of all orifices.
Q) Why can’t we just value ourselves enough to properly nourish our bodies?
A) It appears you are making a couple of assumptions – 1) that all knowledge that has been passed to you, as part of the training for your trade, has stood the test of time and is as accepted as accurate now as it was when it was taught. 2) that the majority, rather than a minority, of people are trying different nourishment options with their eyes wide shut….this may be incorrect.

Hi Richard,
I did include links to a number of studies involving children and the ketogenic diet, not just one paper. I appreciate your efforts to change my mind but I am not persuaded by any of the “experts” you cite. They are all trying to sell something. Keto may have applications beyond those of managing seizure disorders, however, it is not a balanced healthy way of eating for the majority of the population and I believe that promoting it as such causes more harm than good.

yes this!! Great post and I agree with you completely. Great you’ll be thinner… you’ll also increase your saturated fat levels to dangerous levels and drive up your blood pressure, but hey, you’re thinner!